Chronic Renal Insufficiency (CRI) recently was recognized as a silent epidemic affecting more than 10 million Americans. To gain understanding of the relationship between progressive renal disease and cardiovascular illness, the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) established the Chronic Renal Insufficiency Cohort (CRIC) Study in 2001. The principal goals of the CRIC Study are to examine risk factors for CRI and CVD events among patients with varying severity of CRI, and develop predictive models that will identify high-risk subgroups with CRI. The CRIC study did not include an eye component as part of the overall assessment of the patients. Recent studies, however, have suggested that retinal vascular abnormalities due to diabetic and hypertensive retinopathy are representative of the microvascular pathology that affects other organs such as the kidney and the heart. The presence of such retinal vascular abnormalities is associated with a markedly increased risk of progression of renal and cardiovascular disease, among others. The purpose of this ancillary study will be to obtain fundus photographs on CRIC patients to investigate the relationship between retinopathy and CRI and CVD within a population of subjects with CRI. In addition, we will assess whether fundus pathology can provide information of prognostic value regarding the progression of renal and cardiovascular disease. Potentially, non-invasive fundus photography could provide unique information about the microvasculature that would not be available through any other means. Such information could identify new risk factors that would significantly improve the predictive models to be developed through the CRIC study. Additionally, because many of the CRIC study participants are at high risk of developing significant morbidity from retinopathy due to diabetes mellitus, systemic hypertension and other vascular diseases, it is important to assess the ocular condition of patients with CRI to gain a more comprehensive evaluation of the overall pathology caused by CRI. This grant offers a unique opportunity to merge information on the ocular condition of CRIC patients with the vast amount of data that will be collected by the CRIC study, an endeavor that will yield important insight into the relationship between retinopathy and CRI. [unreadable] [unreadable]